A COMPUTER project costing £6.2 billion that is central to Tony Blair’s National Health Service reforms is in “grave” danger of being “derailed”, leaked Whitehall e-mails reveal.

The warning has been issued by Richard Granger, the £250,000-a-year civil servant in charge of what has been billed as the world’s biggest civil information technology project.

The scheme is central to the government’s plans to give patients wider choice by allowing GPs to book hospital appointments online with consultants throughout the country.

The problems have already caused a year-long delay in the booking system and now threaten to add millions to the cost of the project.

To date the system has made only about 20,000 appointments for patients. It was supposed to have made 250,000 by December 2004.

When it is fully operational the system is meant to be capable of making up to 9.5m first hospital appointments a year.

In the e-mail exchanges in September, Granger blames a senior civil servant in the Department of Health for the fiasco, criticising her repeated last-minute changes and failure to heed his advice.

Granger censures Margaret Edwards, the department’s director for access and patient choice, for adding numerous new specifications to the booking programme, known as Choose and Book.

Granger writes: “Choose and Book’s £20m IT build contract is now in grave danger of derailing (not just destabilising) a £6.2 billion programme.”

He concludes: “Unfortunately, your consistently late requests will not enable us to rescue the missed opportunities and targets.”

Sir Nigel Crisp, the NHS chief executive, was forced to admit to the Commons health select committee two weeks ago that the booking system was at least a year behind schedule. However, he failed to mention that the delay was having a serious impact on the entire project.

The National Audit Office has identified changes to specifications after the award of IT contracts as a key reason for regular delays and overspends on government projects.

Granger’s comments were triggered by an e-mail on September 9 from Edwards marked “Restricted — Policy” which begins: “We have a problem!” The e-mail reveals that patients and their GPs still cannot book treatment at any of the country’s 32 foundation trust hospitals by computer because they are not on its “choice menu”.

The 10 private sector treatment centres, set up by the government to reduce waiting lists, are also absent from the official list on the computer.

Edwards warns that the treatment centres and foundation trusts will not be on the “choice menu” until next summer.

The delay places hospitals at a financial disadvantage. Under the government’s payment-by-results regime, they are supposed to compete with other NHS hospitals for patients.

Edwards admits: “We haven’t yet told ministers that there is a problem.”

Granger was incensed by the implied criticism of the booking system and fired off a trenchant 11-point reply. Although Edwards’s original e-mail was encrypted and her password protected, Granger decrypted it, sent it out with his reply and widened the distribution.

Granger complains that the project has been allowed to change beyond recognition from the original specification. “The original request from your predecessor and yourself was for an Electronic Booking System. The change of this to Choose and Book occurred in (the second quarter of) 2003. This was the first of what are now recurrent major changes in your requirements.”

The booking system has been dogged with difficulties since its inception. GPs have refused to use it and early pilot schemes identified fundamental software design flaws.

Last week Granger, who insists that the booking system now works, broke civil service protocol and publicly blamed policy officials in the Department of Health for failing to get GPs to use the system. In an interview with Computing Magazine, he said: “Low usage is not something I can do anything about.”

Both the health department and Granger’s spokesman refused to comment on the leaked e-mails.

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